Treatment of hepatic encephalopathy
Hepatic encephalopathy is not a disease but a manifestation of one, and any symptom control is temporary unless the main problem is resolved. It is also important to make sure that there are no other concurrent neurological conditions and to exclude all possible diagnoses before starting treatment. Your doctor will first record your ammonia level to check the effectiveness of the treatment. Managing hepatic encephalopathy depends on how advanced the condition is and mild cases with mild affection of memory or concentration may not need to be hospitalized but can be treated at home with certain precautions.
If your condition is mild, you may only be given an antibiotic called rifaximin to decrease the number of bacteria in your gastrointestinal system and reduce ammonia production along with a laxative to prevent constipation. More on constipation and hepatic encephalopathy below. In addition, you will be given some instructions regarding lifestyle changes including:
- Diet: You will be instructed to stick to a more vegetarian diet with less red meat and more fiber. Meat is rich in protein, which is a good thing, but excessive protein is doomed to produced more ammonia. Fibers in diet will also reduce constipation, which is essential for managing hepatic encephalopathy.
- Driving: It may not be wise to continue driving once you are diagnosed with hepatic encephalopathy. As discussed above, your concentration and attention span may be affected which can put your life and others in danger. Your doctor will assess your condition carefully and advise you regarding driving.
- Your job: In most cases, your job will not be affected by your condition. However, certain jobs especially those that need special concentration or those with risks may not be possible in those diagnosed with hepatic encephalopathy. Your doctor will coordinate with your work general practitioner, and they will advise you regarding your work.
- Monitoring yourself: There are various methods of self-monitoring including apps that you can install on your mobile phone. Those tools serve to help you evaluate your condition on a daily basis as well as help you maintain your cognitive function. Once a new change occurs in your cognitive abilities, they will alert you to see your doctor.
- Medications: Your doctor will advise you to avoid any medication that can suppress cognition including sleeping pills and some anxiety pills.
If the condition is severe and your need hospitalization. the main focus becomes to prevent further deterioration of the condition, which is achieved by controlling precipitants. Precipitants are the group of conditions commonly associated with liver disease that accelerate the rate of hepatic encephalopathy including:
- Bleeding: Bleeding, especially from the gastrointestinal tract. There are various methods of controlling bleeding including procedures like rubber band ligation or medications like beta blockers. Some more aggressive procedures such as TIPS may be inadequate for patients with hepatic encephalopathy as it can increase the progression as mentioned above.
- Kidney disease and failure
- Infection: Infection increases the number of bacteria producing ammonia and places excessive load on the liver.
- Constipation: Constipation and the gastrointestinal tract is central in the management of hepatic encephalopathy. When a patient is constipated, bacteria have ample time to process food in the large intestines and produce large amounts of food and produce ammonia, causing further neuron damage. Constipation is treated by giving laxatives such as lactulose or performing regular enemas.
After controlling precipitants, the next step is to reduce the production of ammonia through treating constipation and antibiotics to decrease bacterial load. Some medications can also help get rid of ammonia such as L-ornithine L-aspartate or LOLA.